Recurrence after surgery for endometrioma: a systematic review and meta-analyses

• Published in: Fertility and sterility
• Main Authors: Veth, Veerle B., Keukens, Anne, Reijs, Anouk, Bongers, Marlies Y., Mijatovic, Velja, Coppus, Sjors F.P.J., Maas, Jacques W.M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 05.08.2024
• Subjects: Endometrioma; endometriosis; Recurrence; Surgery; endometriosis; Recurrence; Endometrioma; Surgery
• ISSN: 0015-0282; 1556-5653; 1556-5653
• DOI: 10.1016/j.fertnstert.2024.07.033

Endometriosis is an inflammatory disease, with different forms of expression and a variety of complaints. An endometrioma, an ovarian cyst with endometrium-like lining, is one of the most common expressions of abdominal endometriosis. These endometriomas can, in addition to medical treatment, be treated surgically. After surgery, hormonal therapy is still frequently used, for treatment of endometriosis in general and prevention of recurrence of endometriomas specifically. However, not all women want or can receive postoperative hormonal treatment. It is important for this group to know the risk of anatomical recurrence of ovarian endometrioma after surgery for an endometrioma. To determine the recurrence rate for surgically treated endometrioma, without postoperative hormonal treatment. We performed a systematic literature review and meta-analyses, according to the PRISMA guidelines. MEDLINE, EMBASE, and the Cochrane Library were searched until May 2023. The literature search was limited to women with endometrioma who received surgical treatment without postoperative hormonal treatment. A distinction was made in study design including randomised controlled trials, cohort and retrospective studies. For assessment of risk of bias, the Cochrane Handbook for Systematic Reviews of Interventions and The Risk of Bias in Non-randomized Studies – of interventions assessment tool were used. Outcome measure included in this review is endometrioma recurrence. We screened 5367 articles, of which ninety-seven articles were systematically reviewed and fifty-five included in this systematic review. Twelve of these were randomised controlled trials, eleven prospective cohort studies, and thirty-two retrospective studies. Nine randomised controlled trials (RCT’s) were assigned as low risk of bias. For non-RCT’s, only three studies had low risk of bias. Data of twenty-three studies were pooled in meta-analyses, performed for follow-up periods of 3, 6, 12 and 24 months. These studies showed a recurrence rate of 4%, 14%, 17% and 27% respectively. The meta-analysis, at 24 months after surgery the endometrioma recurrence rate showed a weighted average up to 27%. With this study, we aimed to determine the recurrence rate of endometrioma after surgical treatment in women without postoperative hormonal treatment use. Recurrence rates were up to 27%.